“That’s No Longer Tolerated”: Policing Patients’ Use of Non-opioid Substances in Methadone Maintenance Treatment

ABSTRACT

The current overdose crisis in the United States emphasizes the importance of providing substance use treatment programs that are not only effective but tailored to meet the specific needs of the populations they serve. While Methadone Maintenance Treatment (MMT) is considered to be among the best strategies for reducing rates of opioid-involved overdose, its ability to attract and maintain patients may be hindered by a recent focus on policing the non-opioid substance use of people on the program. This paper uses interview data from treatment providers to examine how clinicians conceptualize and organize MMT in regards to patients’ use of non-opioid drugs. Responses demonstrate that some treatment providers are increasingly monitoring their patients’ use of non-opioid substances and punishing them for infractions, up to and including discharge from treatment. This approach will likely result in increasing rates of patient dropout and a lack of new admissions among people who use non-opioid substances. This article argues that including non-opioid substances in MMT’s mandate restricts its ability to improve public health, including by preventing overdoses, and recommends instead that MMT adopt a more individualized approach, shaped by the needs and goals of the patient rather than those of the clinician.

KEYWORDS:

• Methadone maintenance treatment
• abstinence
• harm reduction
• cannabis
• recovery

Acknowledgments

Points of view, opinions, and conclusions in this paper do not necessarily represent the official position of the U.S. government or New York University.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. This study was conducted in New York State where recreational cannabis use is currently illegal.

Additional information

Funding

This work was supported by the NIH/NIDA funded T32 training grant 5T32DA007233-35.